Where would you place yourself on the meds--therapy spectrum for treatment of mental illness?

Right now I’m all meds, no therapy. Would love to flip it. And if I could do cardio on a regular basis, I probably could lay down the meds altogether, right?

I think that one goes illness by illness, and follows best practices as far as each diagnosis is concerned. Medication is strictly indicated in Psychoses, strongly indicated in Bipolar Disorder, strongly indicated in Major Depressive disorder, very useful but perhaps overprescribed in ADHD, useless in Adjustment Disorder, etc.

It just depends on the person. For some, their behavior stems from a chemical imbalance in the brain. (such as depression which I am treated for- therapy wouldn’t help) I think some mental problems such as anxiety disorders may stem from a traumatic event in a person’s life, and therapy might help them get through it down to the root of the cause- but meds could help them feel better in the meantime. I think it really just depends on what is causing the mental problems would determine the way in which it should be treated.

I am with dpworkin. It depends on what the illness is. Sometimes meds help; sometime therapy helps; sometimes (like OCD) a combination of things help.

It is really not a matter of belief.

I see nothing wrong with medication or therapy and I think a balance of both is important if you experience something way more than mild symptoms. However, I don’t think a lot of people understand that medication is not a cure for depression or any other mental illness. For example, it may treat symptoms of depression, but can’t change any underlying contributions to depression. Because of this misunderstanding, they avoid facing their issues and allow them to get worse. This is when therapy comes in handy.

But like others have said, it truly depends on the person. Some people respond really well to therapy and don’t need medication at all and vice versa.
It’s just that when people think they only need medication as they allow any underlying issues to get worse, it becomes a problem.

If it weren’t a matter of belief, then all conditions would be diagnosed and treated in the same way. They aren’t. I know several people who have had a number of diagnoses in their lives and have been on a dozen different meds and have tried half a dozen different therapists. I know people who try to do everything with therapy and refuse to take meds. @marinelife I am pretty sure that belief enters into it quite a bit.

@Vunessuh I think the other problem is probably more prevalent—when people think they only need therapy and meds are just for people who aren’t willing to put enough work into it.

@wundayatta Falsely. People insert their beliefs into the process.

As the others have said, it depends a lot on what is going on with the person (as far as what their options are).

For me personally, I would try therapy first if it was an option and then progress to medications if needed. I have no problem with either one, I just prefer to take as few medications as possible.

@wundayatta Psychotherapy is still transitioning from a field that was all belief and no empiricism to a field that is predominantly empirical. I expect the empirical mode eventually to prevail.

@marinelife I’m very surprised you say that. The implication of your statement is that everything is known, and that is certainly not true. Is there something here I’m not getting?

@wundayatta Yup, it goes both ways.

@wundayatta No, it is not known. Nor are our medical solutions all excellent. Thus, we have side effects. What we do know is what conditions respond to therapy and which ones do not.

@dpworkin I am totally in favor of empiricism. There more there is in psychology, the better. However, human behavior can never be described precisely. It will only be able to be described in probabilities. There is an enormous amount of wiggle room in attributing effects to causes when studying human behavior. Ergo, I think that belief will always play a large role in treatment of mental health conditions.

@marinelife Ah. I see what you are saying now. I would characterize that as pulling back to a very general level. Even then, I would take issue with your assertion, since there are a large number of people where it is not at all clear what the condition is. Obviously, if you can’t diagnose someone precisely enough, you can’t treat them using empirical research.

[Edit]
I think misdiagnosis or inaccurate diagnosis currently occurs in about one-quarter of cases that are actually diagnosed. This does not include people who never get a diagnosis at all. My one-quarter figure is just a guess based on what I see happening in the people I know. Hmmm. I’ll bet there’s data about this. Or at least data on how many people have had their diagnoses changed.

@wundayatta Personally, the only psychoactive drugs I have ever taken were for recreational purposes, and the only therapy I’d ever submitted to was required.

As to beliefs, there definitely is such a thing as the placebo effect. To the degree someone is sick because they believe they are sick, they will recover because they believe in the treatment they get. Witch doctors actually heal some people who do not respond to known cures in aliphatic medicine. That said, most of the population responds best to things that have been empirically established to work. The further we push psychology, the better prepared we will be to treat disorders of the mind. No reasonable person would suggest that a doctor treat a gangrenous foot with some hocus-pocus because that’s what the person with the dying flesh believes in.

For me, the medication works just fine without the therapy. Therapy is sort of an extra for me. I benefit much better from my medication than I do from therapy sessions.

I am on medication mostly for general anxiety and panic disorder, by the way. But, on the other hand, we haven’t dealt with any sort of techniques to reduce anxiety. Maybe it’s me being lazy, but I’d rather just have the meds do it for me. I’ve had so many panic attacks since The Really Bad Thing that the thought of another makes me… well… anxious.

I haven’t ever been clinically diagnosed but when I was “Depressed” during college, I went for the therapy side because taking drugs for it scares me. (Since I wasn’t diagnosed, I don’t know if these drugs were even an option for me. I just know my mother recommended them.)

I’m all meds and no therapy for depression. I’m on the same meds that worked the last time (18 years ago). Talking therapy does me absolutely no good; the Aspergers Syndrome makes it too painful and confusing for any kind of face-to-face interaction to work. I don’t like the idea of my mental health being hostage to a pharmaceutical company, but I have no option.

So many conditions we used to think of as being “all in our heads,” as it were, are chemically based. There’s little difference between taking meds for that just as you would for diabetes or high blood pressure.

That being said, therapy can often help as a companion treatment.

@stranger_in_a_strange_land: Talking therapy does no good for me either really, but my dad gets mad if I don’t go. Damned nurses. I don’t have AS, but my general practitioner happened to hit a home run with my med combo… unlike most people, I am normal again and not numb or emotionless… and that’s the biggest part.

@poofandmook That’s great that he got the combination right. I have to live with the numbness, but it’s better than being suicidal I guess.

While I do think that some cases involving actual brain chemistry issues may warrent medications, in general…I believe all problems are psychological and all soloutions are spiritual.

Not that medication and spiritual growth cannot go together, but..IMO, the vast majority of mental and emotional problems are born of a bereft spiritual life where the focus is turned outwards, an extreme focus on self, lack, pain, a victim mentality, rather than an inner focus on ones higher self and a selfless approach to life.

It would depend on the illness, but I would not rule out any treatment, medication or therapy, that might help me.

What does “spiritual” mean? What does “higher self” mean? How can a “self” be “selfless”? I’m having trouble understanding your whole post.

A combination of the two is usually ideal. I don’t see any benefits of a “meds only” prescription. Psychotherapy is almost always helpful—there’s no downside to it. Meds working together with therapy seems like the most reasonable path to me.

My therapist doesnt do insurance and i cant afford him right now…...so it’s on with lexapro….and waiting for a miracle and a new day.

what about the unexamined life???
we all need to look into what gets us down.

@dpworkin

The small ‘self’ is ego. Only concerned with it’s own petty desires. What it can get, how it feels, how it’s been wronged, slighted, how unfair life is, creating an entire identity out of ‘me & mine.’ Selfish.

The higher ‘self’ is the God self…selfless, more concerned with what it can give, rather than recieve. Realizes it’s eternal nature and is not held captive by the ever changing life situations in the world of form.

It is the ‘self’ that is in tune with the temporary nature of worldly desires and recognizes itself for what it truly is…pure consciousness.

‘Spiritual’ means recognizing the oneness of everything with the eternal, no separation.

Ego thrives on separation.

That’s the best I can explain with words that can only point to the experience but not be the experience.

You’ll know it when you experience it, otherwise it’s just another concept. ;-)

You lost me.

I’ve been in therapy most of my adult life, on and off of course. I didn’t even try meds until about 4 years ago. I’m trying therapy, yet again, and switching-up my meds so that maybe, just maybe, everyday will not be a struggle to exist. If I had not have gone on meds when I did, I wouldn’t have lived to become a Jellie.

Right now, no combination of therapy and meds is helping me overcome my issues, it just helps me cope. My new docs seem to be hopeful. Maybe some combination of therapy and meds will actually work some day.

@dpworkin

lol…I expected I might…no big deal, one’s ‘spiritual’ growth is a very subjective thing.

I think, to simplify my thoughts…if you notice, most emotionally unwell people are obsessiviely concernd with self.

Every moment is spent evaluating how THEY feel, what THEY want, how THEY are depressed, sad, angry, hurt, lost, confused, unhappy, etc. ( fill in more blanks )

My point is that they make themselves into their entire universe which shrinks to a smaller and smaller realm by the moment.

Soooo…my point is…unless they are truly suffering from some biochemistry issues, they don’t need a shrink or a pill, they NEED to get out of themsleves and find a way to put the focus on the bigger picture, the greater good, instead of wallowing in a self imposed prison of ’ all about ME, all of the time!’

I guess I don’t find that to be the case. When I meet people with psychological difficulties they all seem to need assistance. If someone engages in the sort of behavior you describe, my assumption is that there is some major fundamental blockage interfering with his or her ability to interact with people in a socially adaptive way, and that they would benefit from therapy, perhaps medication.

@dpworkin You don’t get it because you are educated about these issues and know the reality behind it. Mental health can not be minimized to an abstract, non-empirical idea such as spirit.

@dpworkin

Yes, sometimes. I have utilized therapy a couple of times when I have felt blocked in some sort of progress. But..I have also learned in my experiences and observations that a whole lot of peoples issues stem from nothing more but pure self centeredness as well.

Being ‘unwell’ is a great attention seeking and manipulative way to get needs met.

For some the payoff is big enough to keep the status quo afloat.

Therapy only works if someone is truly motivated to drop their all suffering self image.

I agree that motivation is important, but I find your vocabulary to be thin and imprecise.

@Coloma I think you do a disservice to those with emotional problems to say that by focusing on spirituality they can just get better. That is not necessarily true. There are a myriad of problems in the arena that are not self-fixer uppers.

@dpworkin
@marinelife

Not my intention…just saying there are many ‘truths’ and a goodly amount of mental illness does have it’s roots in a lack of spiritual grounding and gross narcissistic selfishness.

I’d say it could easily be a 50/50 split…just tossing around some alternative thoughts here of which I absolutely believe to be as true as everything else.

If someone is hellbent on clinging to their suffering they will defend that right vehemently, just as someone who is truly ready to be well, nothing will stop them.

That’s all…not interested in getting into a right/wrong debate. :-)

@Coloma makes a good point in saying that people tend to internalize their problems: “The world is only unfair to me,” “I’m a failure,” “No one loves me.” However, I am not so sure spirituality is a reliable solution. Cognitive therapy helps people overcome that way of thinking and take up a more rational, fair view of themselves and their environment.

It depends upon whether a person has developed an internal or an external locus of control. If they feel like victims, there are cognitive means of teaching them that they can control events for themselves. I don’t read this as being a “spiritual” failure.

@le_inferno

I like the combo approach of both…hence the term ‘Psycho-spiritual.’ :-)

If someone is open to alternative therapies there are many untapped and non- ‘traditional’ venues to holistic health.

I utilized a hypnotherapist AND ‘spiritual’ mind power dynamics to kick a smoking habit. I am a total beleiver in the minds power to heal damn near all that ails you. :-)

Maybe not so much internalize but PERSONALIZE. ( Ego)

As if they are the only one’s ever to experience some sort of discomfort or hardship.

@Coloma It sounds like you are talking about a quasi-Buddhist enlightenment which is possible for some people and may help them solve their psychic pain. For many of the rest of us, we are or have been in pain and some combination of therapy – talk or cognitive – and/or medication has been helpful for alleviating it. It it were simply a matter of living on a higher spiritual plane, more of us might not need therepeutic help but you can’t often get there from here.

As many of you already know, I have a PhD in Clinical Psychology. I did not practice long as I found my other academic skills better suited to my personality and preferred work style.

For many mental disorders, medication is a critical component to achieving a higher level of functioning. Psychotherapy is essential to increase a person’s emotional coping skills, social skills and cognitive skills.

For some problems, therapy alone may be very effective. For others, without chemically controlling the hallucinations, delusions and formal thought disorders, the patient can’t benefit sufficiently from therapy.

The use of drugs and type of therapy must be determined on a case by case basis. Their home environment, their support system, their previous level of functioning are all important considerations.

I hope this answer is helpful to any of you dealing with mental problems that affect people in your life.

@janbb

I understand.

I am just big on being open to any and all paths to ‘recovery’ whatever that might mean to an individual, especially any that reduce or eliminate drug therapies if at all possible.
I do believe that a ‘spiritual’ practice ( not just intellectualizing ) is beneficial for those that are open to deeper exploration.

There are many good therapies and I am a leave no stone unturned kinda person. ;-)

I’ve had both in the past, for depression, and I found the meds successful and the therapy patently useless. But the only real cure for me was a new job.

First, to answer the question, I am a bit uncomfortable simply stating my diagnoses here. I suffer from bipolar disorder among other things. It makes me uncomfortable to name the other things because I write a blog on a medical web site, and someone with enough resourses could find me. Prejudice still exists in the world against people with diagnoses like mine, and I don’t wish them to know about it.

So, let’s just leave it at bipolar disorder.

The question asks where I am presently on the meds – therapy spectrum. I’d say I’m about 60 – 40 meds to therapy. I am thrilled with the therapist I have and talking to her gives me real valuable tools to use in life. At the same time, I recognize that my disease would not allow me to even talk to her coherently without the medications that I take.

Many of the tools that I use are not related to the medication, like exercise. I cannot truthfully say that I get the proper amount of exercise right now, because I recently moved. I used to live near a beautiful park where I would power walk 6 days/week. I can’t get to that park easily now, so my walking has stopped. I have every intention of restarting it, but I can’t at present. I am putting this paragraph in here to mention that I believe exercise is an important part of my overall plan of dealing with my illness.

There has been a lot written in this thread about spirituality. I am a firm believer in the benefits of practicing a spirituality. I pray and meditate, and I think that it helps calm my ever-racing mind. I can’t say that I practice a specific form of meditation, because with my brain, those don’t work.

I wholeheartedly disagree with the idea that spirituality alone can cure what ails me. That assertion leaves the door open to the classic logic of blaming the victim, i.e., “if you just believed this, you’d be better,” or “if you practiced this form of meditation, you’d find enlightmenment and be cured.” Poppycock.

Do you see the conundrum? Those attitudes degrade the person with the mental illness by asserting that they have control over their ailment. As a person with mental illness, that attitude insults and enrages me.

I hate to say that I have control over my disease, yet I continue to practice using tools that I know help me with it. I take medications on a daily basis as prescribed, I see a therapist and tell her everything that is happening with me, together we work out strategies for dealing with my problems, I exercise, and I pray and meditate. These things are not control. They are tools.

Edit “therapeutic” of course.

Absolutely brilliant discussion and elucidation of the issues, @hawaii_jake! Thank you very much!

@hawaii_jake

Exactly…utilize as many methods as help you but undermine none.

I understand there is a big dif. between a situational depression and a chemical misfire.

It would be the best of all possible worlds to just take a few tests and assign the perfect combination of medication/therapy possible. What I hate is the experimental part of it all. This doesn’t just happen in mental illnesses.

My doctor has determined that I have a thyroid malfunction, high blood pressure, cholesterol, and lately diabetes. Her solution is to try this medication, in that dose, or maybe change to another one, and then add this, or that. The result is I don’t really know what is wrong, and what helps or doesn’t help.

To make matters worse, my own body undergoes it’s own schedule of releasing hormones and metabolizing foods in seemingly random sequences, and it overrides whatever attempts my doctor and I make.

As @dpworkin says above, some illnesses are treatable with medication, while some [personality disorders, say] are notoriously resistant to medication and need cognitive-behavioral therapy. Some may need both. a combination of major depression and a personality disorder might need both.
In the past 15 years or so has been a movement away from a psychiatrist handling both aspects to a team of prescribing psychiatrist and therapist.

By far the best scenario is a highly trained counselor working with a distinguished psychopharmacologist, who may consult monthly.

Side question: A therapist friend had said that personality disorders are pretty much untreatable either therapeutically or medically. Is this true and also, what is the definition of a “personality disorder”? (I believe narcissism is one.)

Personality disorders are defined in the DSM on Axis II Cluster B. Wikipedia has good summaries of the diagnostic criteria. The diagnoses can be sloppy, because of a certain amount of overlap, and because of gender bias (women are more likely to get a diagnosis of Borderline or Histrionic.)

It has long been thought that personality disorders are intractable, until Marsha Linehan (qv) proved beyond any doubt that Borderlines can be cured. This has set off a rush to see which other disorders may yield to treatment. It is my personal opinion that any disorder save “Callous/Unemotional Antisocial Personality Disorder” can be mitigated at least somewhat by properly directed cognitive-behavioral therapy along, perhaps, with carefully controlled medication.

Aha, thanks; will read up further in those sources. I know a Borderline who was helped a lot by DBT.

@dpworkin

Are you a therapist or just an armchair shrink?

I agree that there are certain ingrained behavioral patterns that cause dsyfunction, but…the pop psych hype of glorifying PD’s has gone too far in my opinion.

Do they exist…certainly…and, of course, like anything, by degree.

However, I think that this surge of labeling every difficult person as a potential PD is BS.

I am no stranger to reading about these various issues but, all that personality disorder means to me, are people that I avoid at all costs due to the destructive way they show up.

I, of course, have empathy..but think this whole PD thing has gotten out of hand and gives carte blanche for people to say they just can’t help themselves, or, and perhaps worse…has laypeople putting everyone under the microscope for some just plain human traits. Not happy or healthy traits but not necessarily a fullblown PD either.

Also…many Pd’s do mitgate themselves with age and maturity… ( not including about sociopathic types) therefore, IMO…much of what is labelled a PD is really just immaturity, not to say that the destructive side of either immaturity or a true PD person does not have some common outcomes.

EVERYONE has some traits of a PD…just depends on the pervasiveness.

@Coloma I am neither a therapist nor am I “just an armchair shrink.” I am a serious student of psychology; I am in graduate school pursuing a Clinical MSW. Can you disagree with me without the ad hominem, or are you insufficiently creative?

@dpworkin

There was no ad hominem attack in my resposne.

I asked a valid question with no negative intent.

I know that there is a shift in some areas of psychology towards a focus on positivity rather than pathology.

I am simply saying that I think that it has become way too acceptable to jump on the pathology bandwagon without factoring in many other possibilities.

As an example…your first thought was that I was attacking your credibility…now..if I was overly identified with pathology I might assign a ‘paranoid’ or ‘narcissistic’ ‘label’ to your reaction and reply.

Take ONE trait of say narcissism such as an over sensitivity to perceived criticism ( narcissistic injury ) and run with it, feel a need to return the perceived slight perhaps by baiting the perceived critic with something such as..oh, I dunno…a challenge to their perceived lack of creative sufficiency? lol

Note: I am using diffusive humor lest you perceive it as otherwise ( A trait of an emotionally healthy person ). ;-)

I interpret “just an armchair shrink” as pejorative. How do you interpret the word “just”? And you may have read my post, but it seems to me that you misunderstood it entirely. Perhaps you may wish to try again.

@dpworkin

Well…you nailed it with ’ interpret’ which could also be reframed as assumptive.

‘Perjorative’ completely escapes me as an interpretation, sorry.

I would think that as a ‘serious student’ of psychology one of your first thoughts might be to ask what my meaning was and to perhaps look at why your first assumption carried such a negative interpretation.

I asked a direct question peppered with a bit of wry humor. ( If you read many of my sharings you would get a feel for my humor. )

I used the word ‘just’ as an inquiry as to the level of your expertise.

I did not misunderstand your post..I have simply noticed that this area seems to be something you are knowledgble in and therefore, asked if you were a therapist or ‘just’ an armchair ‘expert.’

As we all know the world is full of ‘professionals’ with entire alphabets following their names, but..doesn’t mean they are credible, ethical or good at what they do. lol

I am ‘JUST’ a 30 yr. armchair psych hobbiest ( along with some real life experience with ‘disordered’ types, some certified and some ‘just’ your run o’ the mill impossible people.

I am knowledgable but not licensed, have thought about returning to school, but not interested in picking up another career at this time.

At risk of being blacklisted I am observing that you seem adverse to looking at the possibilities of your own transferences, assumptions and random interpretations devoid of open and non-defensive inquery.

I may be a layperson but I do know that the most important ‘work’ of a therapist is to constantly be watching and inquiring of themselves first and foremost of all.

Of course you are ‘only’ human and just because one is a ‘serious student’ does not mean they themselves don’t still have plenty of work to do.

I see a lack of inquery,gentleness and humility in your responses….guess I am the mirror for today. lol

What the fuck are you on about? You are pretending to be my therapist now? Take a hike.

Whoa!

You sure have lost all credibility with me dear ‘doctor.’

Is this how you plan on handling your patients?

Scary!

Hike in progress.

@Moderator This thread may be spinning out of control needlessly.

@Dr_Lawrence

Surely you can pinpoint the launch…not my rocket. lol

I have the greatest respect for your contributions.

Not that the OP has any standing any more, but I am quite enjoying the byplay, and I see it as constructive and related to the topic. We have two people with different theories about therapy, who are coming from different backgrounds and who have two different ways of presenting themselves.

While some borderline elements of ad hominem arguments have entered into it, I still think they are managing to keep it barely civil enough.

@dpworkin generally seems to fall on the “whatever works” treating the patient individually side of the debate. @Coloma is most certainly more of a therapy bias with a belief that people should be able to handle most things on their own. She is also more skeptical of the practice of psychology because of her bias.

I have seen both of them write in what I would call a “prickly” way at various times. I see this as a clash of personalities, and that is emblematic of some of the stresses I see in society in terms of perceptions of the practice and value of psychology.

@Coloma is very much (I think) a “do it yourself” kind of gal. @dpworkin is more of a pragmatist and a “by the book” (DSM IV) kind of guy. He relies on his expertise, and she relies on her experience. Book learning vs experiential learning.

She can easily get his goat (if he lets her) by attacking the very notion of degrees and professionalism in this discipline. She’s tried similar things against me in the past. Sometimes I rise to the bait, but mostly I let it go.

I think it is legitimate to discuss the source of one’s knowledge. I think it is legitimate to critique the source of someone’s knowledge. Of course, in doing so, the line between critique and personal attack can be very blurry. In this case, I would urge leniency, for I feel pretty sure the adversaries (if indeed they are adversaries) will draw back from the brink before the glove is thrown down (to mix a metaphor).

Hell! They can gang up on me if they like! ;-) Nothing like a third adversary to make the other two band together.

You don’t know anything about me, my bedside manner, my efficacy as a therapist or my training. All you really know is that I find you annoying enough to want you to go away.

[Mod says] Personal attacks removed, please continue this discussion without resorting to personal attacks.